How Our Teaching "Worldview" Impacts Learning: Applying the Teaching Perspectives Inventory to Practice

Thanks so much for having me. Um I'm Paul. I'm a general internist um at Penn State was said. Um, what we're going to do for the next hour is not talk about how to write objectives, not talk about how to facilitate a problem based learning group, um, not talk about how to use lesson plans to to create a a session that is engaging for the learners. All of which is super important. Um what we're going to talk about is the perspectives that we bring from our background um and what our what our teaching identity what our teaching world view is. I had the opportunity to sit down with Lee this morning and I understand that your medical school is organizing around three aspects of identity in the curriculum. the identity of a master adapted learner, the identity of a of a of a scientist, how we bring a scientist's identity into our work as clinicians, and the identity of a systems thinker. I love that. And I and I will say in my work with the students at Penn State and before that at Baylor, these things were either implicitly or explicitly working their way into my teaching, too. So identity, I think, is a really important part. And this is the opportunity for us to think of our identities as teachers. And so what we're going to start with is the teaching perspectives inventory. So what I would invite everybody to do and we're going to I'm going to give like five minutes to it till about um till about 12:10 or so. Um to do the teaching perspectives inventory. This is a battery of questions. Um, you can get to it through either the link that's on the slide or the QR code. Um, there's a bunch of demographic introductory kind of kind of screens to go through. Go through those as fast as you can um, till you get to the the beliefs, the intents, and the actions questions. And you want to fill it out about one instance of your teaching. In order to get usable data, you need to be thinking about one time you were teaching over the last month. And it can be any venue in which you teach. If you're a clinician and we're teaching on the words, if you're a scientist and we're working with grad students in your lab, that's fine, too. It just needs to be one aspect of your teaching activities that you do. Think about that one aspect as you're filling it out. So, I'll give you a couple of more minutes and then and then we'll start unpacking what we see. When you get to that final screen, it gives you sort of a PDF with a bunch of bar graphy kind of things. Just sit on that screen because that's what we're going to work with. We'll tell you this. about one more minute then we'll So I when I was looking for a picture to put on sort of the top level slide for this knowing that we're talking about we're going to talk about teaching perspectives and teaching perspectives inventory. Um I I really like Cher's drawings because Cher was all about what you see depends on what your perspective. So in this particular one, whether the whether the the guys are perpetually going up the stairs or going down the stairs kind of depends on the the perspective that you're bringing to it. And that goes for teaching, too. Um, so here are the objectives for today. I'll give you a minute to read them. and we're going to be talking about a number of different perspectives on teaching. Um the guy who did this work originally was guy named Dan Pratt. He's a professor ameritus at the University of British Columbia. Um I have my signed copy of his book here, but I will point out um to me the key piece of his book is the subtitle which he calls mapping a plurality of the good. And if Dan were here, I'm guessing what he would say is that no perspective is good and no perspective is bad. There's five different perspectives and they are all equally valid and they describe what we're bringing to our work as teachers. I find myself these days trying to incorporate aspects of all the perspectives into my teaching, but I know that I have certain defaults that when I'm not thinking or when I'm under stress, I'm do defaulting toward. So what we're going to talk about um as we get into the teaching perspectives is I I tend to take a simplistic view of teaching and learning and I boil it down to two sets of activities which are which are interrelated and they bleed into each other but I tend to think about them separately in my mind for to keep things clean and those two sets of activities are design and execution. So design, if you were doing a problem based learning um uh activity with students, design would be the case that you write and execution would be your facilitating the students in that case. Um and the and your teaching perspective impacts both design and execution. It sits underneath the way you design or the way we design and the way we execute. And so we're going to consider both design and execution and their intersection with perspectives. Here's a quote from Pratt's book. Um, I'll give you a minute to read it. I think I find the idea of the lens through which we view teaching and learning being critically important. And I took the TPI probably oh I don't know 15 or 16 years ago and if I would have taken it when I was just out of residency 30 years ago I'm confident that my TPI profile would have looked much different than it does today. Um, part of this idea of a master adaptive learner is that true masters are never done working on their craft. Um, which which I I put in my bio. I couldn't even remember that I put that in my bio. But it's not an accident that that was the first line of my bio because when you meet with Dan Pratt, who's one of my top five teachers of all time, Jed and I have watched him teach and he is breathtaking the way he works a classroom. Um, when you talk with Dan Pratt, it becomes clear within about 15 minutes that as good as he is, he's not done working on his craft. And so, not only are we not done working on our craft, not we're also not done thinking about what the craft is and what it's all about and how teaching and learning actually work. Okay. Does everybody have a TPI profile sheet? Now you should have the the thing should have spit this out at you which is your TPI profile. Here is an example TPI profile. There are two lines I can't put on the screen. There are two lines I'm pointing actually there's three lines I'm pointing at the top line and bottom line. These are the line of dominance and the line of recessiveness. the middle line and the mean line for you. And everybody has a different set of three lines and they may be closer or farther apart depending on how your answers were to the questions. Each box represents one of the five perspectives and we'll get into what the perspectives are in a minute. Um, and if you have a box that is at or above the top line, that is your dominant perspective. It is possible to have two dominant perspectives. If all your boxes are on the same line, if all your boxes are the same height, chances are you weren't thinking about one particular thing when you filled it out. So, you might want to go back and try it again. But most people should most people have one or two dominant have one or two subdominants. So this particular person is developmental dominant and they have subdom dominance of apprenticeship and nurturing and they have recessives of transmission close to being recessive and social reform is recessive. So that means this person when they're designing stuff, when they're actually in the classroom executing, when they're on the wards, teaching on the wards is going to tend toward a more developmental perspective in the way they teach. Okay. Oh, yeah. Let me bring in the All right, that's where I want you to. Okay, everybody got a hand out. Now, just by way of example, um, what we're doing right now with me talking at you would be most consistent with a transmission perspective. Now, I will tell you that transmission is my recessive. So, I'm feeling pretty uncomfortable right now and I'm going to be in transmission mode for about two more slides and then we're going to get into my sweet spot which is developmental. The question is there the these five perspectives. These five perspectives come out from several hundred interviews that Pratt and his colleagues did um more than 30 years ago with teachers across Canada and a whole lot more actual observations of those teachers teaching. And what they realized is that people really sort of have one of five or some combination of five belief systems. And sitting under those belief, sitting underneath those belief systems is a conceptual model for teaching and learning. And this is that conceptual model. And it has three, it has six elements on it. It actually has seven, but it has six main elements. Um, three of those are the teacher, the content, and the learners. And the other three are the lines X, Y, and Z that connect the that connect v that are various connections between the three. So you got a line between learners and content. You have a line between teacher and content. You have a line between teachers and learners. Sitting in the background is ideals. Ideals tend to be your your view of the big picture that has to do with the content that you are teaching. So how many people are basic scientists here? We got any basic scientists? So basic scientists as you are teaching the Kreb cycle remember you're going to your your ideals might be different with a grad student than they are with a medical student. And I know the basic scientists at my in institution that I talk with, they get uncomfortable when they're teaching the medical students because they're like I don't know how this plays in medical practice. And what I usually say is the way to think about your content with these future doctors is you've gone to doctors. Which ones do you like? And how would those do how would you project that those doctors would use this content when they're doctoring with humans? That's sort of the the underlying field that sits underneath it all. But really five of the four of the five perspectives have to do with the other elements on the model. I'm going to show you two and on your handout you have all five. So you have the conceptual model and each perspective has its characteristics for what it's like but each perspective also has its challenges. So one of the challenges of the transmission perspective is keeping people is keeping people engaged. my uh our our associate dean for curriculum and I like to stand in the back of the classroom sometimes when when a lecturer is lecturing and ask is it education or is it edutainment because the History Channel is really good edutainment and it comes in one ear and it goes out the other and tomorrow I don't remember anything about it but it was really fun to be in at the time so it's good edutainment and sometimes our lecturers are not good edutainment Sometimes they're edutainment, but what we want is education. Meaning those learners need to be thinking as we're talking. And one of the one of the challenges of the transmission perspective is how do you know? How do you know whether they're thinking or not? So here is the transmission perspective. The transmission perspective prioritizes the line Z. It prioritizes the relationship between the teacher and the content. And what the teacher is doing is organizing the content and delivering it to the learners. So the line goes from teacher through content to learners. The learner is the final recipient of the con content. I'm going to give you the one that I think is farthest from transmission perspective now and that's developmental. This would be the essence of something like PBL. In developmental the priority line is between the learners and the content directly. The learners directly engage with the content and now the teacher engages the content through the learners rather than engaging the content directly. The what Dan always said to me is the essence Dan Pratt always said to me was the essence of the developmental perspective is that the teacher puts themsself out of a job. By the end of the semester the learner should be so good at engaging with the content that they no longer need you anymore. So you see how these two different perspectives look almost like polar opposites of one another. and the nurturing perspective and the uh the apprenticeship perspective have variations on that and the the social reform perspective is really about um raising uh learners awareness of the social forces. So the one unique one is the social reform perspective which goes through the ideals to both learners and content. And I will say that what Pratt would say is it's a vast m it's a vast minority of teachers who are dominant on the social reform perspective. Okay, that's the crash course. Let's look at this through we're going to look through design and then we're going to look through execution. So um what I'll ask you to do is get into groups of three. So find two other people around you and say hello to your to your friends and your group. Folks who are on Zoom, we're going to be putting you in three breakout. How many people? 28. So, we'll be putting you in this breakout room called Zoom. So, that'll be your group. Okay. Now, the folks that are on Zoom, I'm going to put a What happened there? Uh oh, that's okay. So, what I'm going to do is I'm going to throw up a slide. Don't start the breakout rooms until people that are on Zoom take your camera and take a picture of the slide so you have the question so you can talk with it. So you can talk about it. Okay. So here we go. So we're on design. Our first question is going to be I wanted learners to better know the mechanisms of common drugs used in in psychiatry. Can you move can we move that a little bit? Yes. Move it. Just move it over into the purple. All right. So I wanted learners to better know the mechanisms of common drugs used in psychiatry. So I created an interactive comic book about the characters Glutamate Gwen and Dopamine Dan and distributed this to learners to use during their psychiatry lecture series and then I compared their scores on the psych shelf exam to a historical cohort. Now these questions are not super clean and that's by design but the question is a simple one. Which perspective is my method most compatible with? Developmental apprenticeship, social reform, transmission or nurturing? So you have your cheat sheets, which is the handout. So you have all the perspectives. I'm going to give you three minutes. Three minutes in your group. The rules are you need to reach consensus on one answer and one answer only. Be prepared to discuss why you think that answer is better than the others. Go. Folks on Zoom. US consensus on an answer. [Music] No, I do not actually. But they're I was thinking I might change that. All right, one minute warning. One minute to come to your final consensus. It's amazing. It's so interesting how we all Okay, let's bring it together. Let's bring the let's bring the folks in these in the chat. All right, here's what we're going to do. One person from each group is the answerer. And you've got five choices. One, two, three, four, and five. So, I'm going to count to three. And at the count of three, you're gonna hold up your hand with which number your group chose. Folks that are on Zoom, what I want you to do is throw the number that your group chose into the chat. It's taking about 30 seconds for Oh, it's got to be one minute before we kick you back. Okay. Okay. So, so this gives you 30 seconds more to to have final arguments. Final answer. Okay, we back. Okay, Zoom people, welcome back. I'm going to count to three. What you can do on Zoom is start throwing your answers in the chat box. One through five. Um folks in the room, here it comes. One, two, you should know who's going to answer. The answer person knows what hand, what hand they're putting up. Three. Hold them up. One, two, four, five, one, four. So, we are everything except for social. All right. What do we got coming in the chat box? We got one, two, four, two, and two. Okay. So, we're we're all over the place. So, um, somebody here in the room, tell us what your group was thinking. Folks on Zoom, throw into the chat box your thoughts for why you chose what you chose. Okay, somebody go speak real loud so the Zoom folks can hear you as well. Go ahead. Here and then you start talking. I'll let you go. So we were torn between four and five and so I just raised the hand for five. Um but I think when you are looking at you know how they're creating this story it's providing like a nurturing connectivity uh component to the learning um and generating that interest in them. So I think it's more nurturing but it is transmissive at the same so kind of a nurturing transmissiony kind of thing going on. Yeah. Go ahead. Um we picked apprenticeship because when it did start with the instructor creating the thing that they were going to do that's that content delivery. So we kind of looked at our maps and said okay it's one of these things. So we figured they were going to the content first but then it was the learners engaging. So it was giving them a little bit more ownorous on them to come back which um let me get the they're in the process of inculturation into a community of work. Yeah, I love that. I usually think of the apprenticeship perspective as see one do one teach one only I only I replace teach one with get feedback on one. So So I show you it then you do it and I give you feedback and we go through iterative loops like that. So I'm I'm seeing all of that here except for maybe the iterative feedback loop, but you could build that into the comic book itself. What else? Other folks, what are we thinking? And we said transmission just again because basically it seems like the teacher takes the content, organizes the content, and then produces the content to the learners in a very particular way. Um, and so it seemed um I think more direct I guess in terms of that that arrow seem to be that backwards feedback to the teacher. I mean we were discussing that it was inspiring to or aspirational to be number one developmental but it was falling short was becoming more transmission because of that aspect. If the students were to create this tool themselves then it would become more developmental kind of approach. and realize what we're getting into here. Um I I I do agree that um as the teacher, you are organizing the content and handing it to the students. Think of the conceptual model now. It's you and the content coming to the students as opposed to students directly intersecting with the content. Sometimes we say the students are not ready to engage with the content. They'll get them they'll get it wrong and my job is to ensure that they get it right. Have you have you heard this or felt this before? That is essentially a transmission perspective view of it. Um you all know the first the first rule of teaching learners will perform up or down to your to um to your expectations. So if you want learners to perform better, you need to raise your expectations. Now how often do you hear medical students aren't ready for this yet? You hear that? learners will perform up or down to their to your expectations. So if you lower their your expectations, they'll perform worse. Now, let's talk about our learners for a minute. This is medical school. Okay, I'm I'm going to ask you to divulge trade secrets. So, um if you if you tell me your secret, I'll tell you Penn State secret. How many applications do you get for your medical school? 6,000 for 30 for how many slots? 56 for 56 slots. Okay. We get about eight for 140. So your numbers are even more competitive than ours. Okay. These are the Ferraris of learners. If I were to give you a Ferrari, would you take it out and drive it at 20 miles an hour? Yes. If I were to give you a Ferrari and a closed track with no other cars, would you drive at 20 miles an hour, right? We're working with the Ferraris and learners take these babies out and see what they can do. Learners will perform up or down to your expectations, which is which is one of the challenges of the transmission industry. I uh Yeah. Anything else for this one before we move on? We struggled between uh developmental and nurturing. We thought it could have been either one, but we end up going with developmental because it said I created an interactive comic book and it was like a good teacher creates scenarios and engage learners with content. We kind of focused. I think that's kind of what tipping. The essence comes to what the interactivity looks like. Whether it's tipping from transmission to developmental. Don't ask me what the right answer is. There is no right answer. You could you could play this any way you want, but it's the way we're conceptualizing the perspectives. I will tell you Penn State has once again purchased Osmosis for all the medical students. Do you all purchase anything for your medical students? What do you which one do you buy? UWorld. Osmosis. Uorld. So, so we uh we we just got osmosis. So, the osmosis people were, you know, giving us their spiel and taking us through the videos. And I teach, you know, I teach a bunch of different content, but I'm gearing up to do evidence-based medicine in the fall. So, I'm looking through all the evidence-based medicine content. And the osmosis videos are slick. And they've built a lot of stuff into their platform from the last time I looked at it. Now that now that the big giant Elsiver owns Osmosis, they built all kinds of stuff into that platform was face learning and blah blah blah. And I'll tell you that person giving us the spiel had all the bud buzzwords. She was talking about cognitive load and she was talking about self-determination theory and she was talking about all of it. And at the end of the day, it is a really slick video authored by osmosis people. It's a transmission perspective with all the strengths and weaknesses that the transmission perspective brings with it. Understand what you're dealing with here. And it and it fuels that medical student perception of efficiency, which I find not necessarily compatible with the way human beings really learn, but that's just my opinion. So, so realize if you're going to use osmosis videos, you're starting with a transmissiony thing. And if you don't want to be transmissiony or you want to be something else, um, and and neither is good or bad, there's the the the perspectives are neutral, but you need to think about what your objectives are because if that osmosis video is a prelude to a problem based learning case, realize your learners are going to experience a transmission mode of teaching and then they're going to go immediately into a developmental mode because I think of problem based learning is primarily developmental in its in its mindset, Okay. How we doing? Uh 12:36. You know what? I'm gonna I'm gonna skip the second one. We'll send you the slides. Um but you can look at that one on your own time because I want to get us to uh I want to get us to execution. If I can advance the slides. Try this one. Okay. Okay. So, here we are on execution. This one's kind of complex. It's got a bunch of different things built into it. But, okay. So, now we're we we're gotten off design. So, design is what you're going to do before you get in the room with the learner. Now, we're going to go to execution. We're going to go into the wards. How many people are clinical teachers here? Okay. For the people that aren't clinical teachers, if you're basic scientists, think about the parallel perhaps with a grad student learning some technique in the lab. You're rounding on a patient with interstitial lung disease and you and the student are discussing that the patient has dry rails. The medical student asks you, "How can you tell the difference between wet and dry rails?" And you have your option of one of four one of these four different response choices. The question is which of the perspectives are represented by each response choice? So you're going to look at the four and try we're gonna go through the four and say what perspective does this look like? So response choice number one is the student says what's the difference between wet and dry rails? And you say how do the words wet and dry relate to lung diseases? And you use that question as an entree into probing the students past knowledge to help them discover their way to a new working knowledge of the pathophysiology underneath wet and dry rails. Okay, choice two. Student says, "What's the difference between wet and dry rails?" You and the student both then go to the patient, listen to their lungs. You have the student describe what they're hearing. You tell them what you're hearing and how the sound comes about given that patient's interstatial lung disease, how the pathology works. Number three, student says, "What's the difference between wet and dry rails?" You say, "Dry rails generally sound like Velcro and wet rails generally sound like blowing bubbles through a straw." So, you go home tonight and try these two things out. And choice number four, a student says, "What's the difference between wet and dry rails?" You ask the students, "What experience, if any, do you have with hearing high and low frequency sounds?" And to this question, the student responds that they were in the marching band throughout high school and college. So now you and the student make a plan for them to Google wet and dry rails. You can Google these and there's there's uh there's actually some nice recordings on the internet. I checked it out. So, you tell a student to Google Wet and Dry Rails and check out some of the sound recordings on the internet tonight and come back tomorrow with a musical metaphor from their past experience that they can use to decide whether I'm hearing wet or dry rails on the racks. Okay, be clear with what the four different choices are to to respond to this student's question. Okay, with your group, four minutes, one minute per response choice. Decide what what perspective each of those response choices are more most compatible with. Uh folks on the Zoom, go talk about on Zoom. [Music] Oh, I was thinking what would I would do. I mean, I would love transition. Okay. I feel like you're questioning Yeah. It does not, but I mean it looks like something in It's interesting. Okay, one minute warning. One minute to finish up your discussion. That's awesome. [Music] How much time all the zoomers are back? 29 seconds. 29 seconds. You got 29 seconds left. What was that from? Oh, that is that's a different one. Yeah, that was I realize we're running short on time, which is giving me ideas for how I'm gonna change this question for for this afternoon. Um, but let's go through them as as fast as we can um with what perspectives are going on here. And again, nothing is super clean. Um, so yeah, this isn't the textbook. This is real world. Number one, what perspective we think that is. Why are you saying developmental? You never heard us. You know, it's not about the what, it's about the why. If you thought that was developmental, why do you think it's developmental? Go ahead. Because they didn't actually give the answer. They put it back to the student and said, "How what? Why do you think it's like how do you know what wet and dry is like made them go back to their past knowledge instead of just saying this is the difference?" Oh, what do other folks think? We have another developmental in the track. You're shaking your head. No, we we had difficulty with this one. We saw elements of nurturing this one. What what specific elements did you see of nurturing? Well, they really asking increasingly complex questions um and trying to provide some context, but really creating high standards and and coming going from the wet and dry question to the more detailed question looked like it was progressively getting more challenged. I've always personally found the nurturing perspective to be the most difficult one to wrap my mind around. It's the one I continually say to Dan Pratt, "Is this nurturing?" And he's like, "Yeah, not really." Um, and and and the way I've come to think about it is in number one, we're gonna get to nurturing in a minute. In number one, you're looking at the content through the student looking at the content. So you're asking the question that's trying to under unlock what's in that student's brain about this content and then try to put a question in front of them that leads them more toward your understanding of this content or or the truthful understanding. the truth is out there kind of thing which feels kind of developmentally. You're making the student engage with the content directly and you're sort of shaping that engagement. Um as opposed to the nurturing perspective which is where you get to know the student. So you prioritize your relationship with the student and then use that relationship as context to set goals. Okay. Number two. What do we think number two is? I'm hearing lots of apprenticeships. Why? Because you're both doing it. That's kind of the same with a little bit of that interaction, that feedback loop. So, you want to do one feedback one. Yeah. Yeah. Number three. What does that what does that look like? Transmission. Student ask question, you answer the question. Classic transmission. So realize we realize what we're getting here. It's not just it's almost like design in the moment. Student ask a question. You have multiple avenues as a teacher for how you deal with that question moment. You can answer the question with a question that feels developmentally. You can answer the question that feels transmissiony. Those are bookends for the spectrum. Number four. What does number four look like? Why? Making that connection, right? But look at the difference between one and four, which is squishy. One, you're asking the student about what they know about the content. Four, you're asking the student about who they are as a person and trying to leverage what strengths they're bringing to the issue of wet and dry rails. It's still about wet and dry rails, but now you're bringing the students personhood into it as a way to engage them with the content. Okay, hang on. Always. You know, it worked right before. You know, that's how it is. That's because the Zoom thing got moved. I think that I can't assume connection versus a PowerPoint. I hear you. This is a grid from Are you all using any team based learning? TBL not by the Microsian TBLE. This comes from the Team Based Learning Collaborative. You want to see something that will blow your mind? It's very developmental. So, think of your TPI, but check out the Team-Based Learning Collaborative. I have no financial association with the Team Based Learning Collaborative. Um, this is a grid for facilitating. I think it's about more than two-pace learning, but this is a grid of all the different things that you can do when you're executing either in a classroom or on the wards. And it and it and it organizes according to different tasks of teaching and different moves that the teacher could make. Jazz musicians always talk about how many people like jazz. Yeah, that's about average. Um, everybody thinks jazz musicians are making it up on the spot. Is that is that a general is that a general consensus? What they're actually doing is jazz musicians have little riffs. They have little snippets of melody in their head and they're speaking a language with one another, a language that's foreign to mo most of the public, but they're putting they're stringing together riffs. So, the better jazz musicians have a bigger vocabulary of riffs and they're more eloquent in pulling them out on the band scene. These are execution riffs as teachers. And I would encourage you tonight to take a look at this and ask yourself, which ones of these do I do a lot of and which ones of these do I not do a lot of? And the not do a lot of ones might be ones you might want to practice and try to make make part of your repertoire. And if you as you look at the ones that you don't do a lot of, ask yourself which ones might be more uncomfortable for me to do. And then look at your TPI profile because I would argue that many of these align with different perspectives on the TPI profile. And the ones you don't do or the ones you or the ones you might find uncomfortable doing might be ones that align with your recessives on your TPI profile. Your TPI profile is not fixed as your identity is not fixed. It is a constantly evolving thing. So as you think about your development as a teacher both in terms of design and execution, you want to think about what what do I not what are my strengths and what do I not have right now that I want to build into my teaching. Okay, we're down to the conclusions. um which is in the spirit of trying to be developmental because that's my that's my dominant. I'm not going to tell you what the conclusions are. You're going to tell me what conclusions are you drawing from this from this session. Folks on Zoom, throw them into the chat box. I take away um being intentional um and being aware of the aspects that I'm pulling out. I love that. To be to be intentional about your craft is to work on your craft. Yeah, I love that. What else? Yeah, our our particular profiles predisposed to the use of certain risks that we've used successfully over the years and there opportunities to really expand those out by trying on different identities as we all have our strengths and we all have our defaults. You're going to work on your craft. It's probably start time to start working on some of the blind spots. What else? putting structure around some of um some of what we all do and being able to name it creates a common vocabulary so that when we're talking with others about what we want to do in a a team- based environment, we can we can all more quickly kind of understand what what our goals are. I love that you all are an academy of educators. Is that so? Do you get together and like, you know, do your secret handshake and do academy things? Well, we can't tell you. We can't. This could be one set of shared vocabulary. The five perspectives could be your set of shared vocabulary work stuff together. Absolutely. Yeah. I think it's also important knowing which of those is going to help the learner the best based on where the learner is in their own journey because sometimes they really do just want the answer. Like that would just be the most helpful thing in that moment and then another time the more probing thing is going to be more helpful to them. So knowing where they are and what's going to help them at the most but having that repertoire to be able to bounce around. I've been leading a project at um seven different medical schools that the paper needs to be written um that we've we made a we made with Dan Pratt uh an adaptation of the TPI for students so that we could see what students perspectives on what they perceive good teaching to be are. And there's some interesting results there. Students are kind of all over the map. Um, but a lot of them are nurturing dominant. I did hear a little bit as I was walking around the room some folks saying, you know, I'd love to do number four. I'd love to be, you know, be able to have the time to do that, but you just always don't have the time to do it. You see that as like ideal. Every system is perfectly designed to get exactly the results it gets. If you are in a system that is not giving you the time to be a a nurturing dominant person and your profile is nurturing dominant, the question becomes how do I do nurturing in that setting? So I would love for you to rewrite number four for me as a as a nurturing move that is doable in your system. You know, my thought on that is when you're rounding and seeing a variety of different patients, it you may be able to use the nurturing for one example, one patient, and although you would like to do that every single time because of the time you're limited. So, it's a little bit of having to pick when you employ the piece that's going to take longer. I love the idea of doing number four once and then when you get to the next patient turning to all the students and say write down what your thing is. Now go home tonight and think about your relationship of your thing to this and what's going to be your your learning activity and then maybe tomorrow before rounds we'll share one or two of them. Right? So sort of sort of working with the the time constraints that the system's putting on you. Okay. Last side is just an acknowledgement of Dan Pratt from which the the five perspectives spring. I find this framework really valuable to think particularly in where I'm going in my work is thinking about the improvisational improvisation aspects of teaching working on perspectives that I don't have has given me riffs to use. So thank you very much and I will be here up front for any uh conversation afterward. Thanks for coming out.